Evaluation of the Predictive Value of Umbilical Cord Serum Bilirubin Level for the Development of Subsequent Hyperbilirubinemia in Term and Late-Preterm Neonates

Document Type : Original Article


1 Neonatologist, Associate Professor of Pediatrics, Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Neonatologist, Assistant Professor of Pediatrics, Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Considering the increasing rates of early hospital discharge and kernicterus in healthy full term newborns, timely identification of neonates at risk of severe hyperbilirubinemia is of great significance. The aim of this study was to investigate the predictive value of umbilical cord serum (UCS) bilirubin level for subsequent hyperbilirubinemia. Moreover, we compared the predictive value of UCS bilirubin with that of risk factor assessment and predischarge bilirubin level.
Methods: In this prospective, cohort study, 450 healthy neonates born at the gestational age of ³ 35 weeks were included. UCS bilirubin concentration, direct Coombs test results, and blood group were determined in the newborns. Total serum bilirubin level was re-assessed before hospital discharge. The subjects were followed-up for 1-4 days after discharge and the total serum bilirubin level was measured in neonates with clinical jaundice. Results of the assessment of risk factors for hyperbilirubinemia were recorded.
Results: In total, 319 newborns were followed-up within the study period. The mean UCS bilirubin level in non-icteric and icteric neonates was 2.35 and 2.49 mg/dl, respectively. No significant relationship was found between UCS bilirubin level and development of hyperbilirubinemia (P=0.30), whereas a significant correlation was detected between predischarge bilirubin level and development of jaundice (P=0.009). Gestational age, birth weight, history of jaundice in siblings, and mode of delivery were the clinical risk factors which showed a significant correlation with postnatal hyperbilirubinemia.
Conclusion: Based on the findings, UCS bilirubin level could not predict subsequent hyperbilirubinemia. Therefore, the best predictive marker for neonatal jaundice is the assessment of clinical risk factors and predischarge bilirubin level.


  1. Ebbesen F. Recurrence of kernicterus in term and near-term infants in Denmark. Acta Paediatr. 2000; 89(10):1213-7.
  2. Maisels MJ. Neonatal hyperbilirubinemia and kernicterus - not gone but sometimes forgotten. Early Hum Dev. 2009; 85(11):727-32.
  3. Stevenson DK, Fanaroff AA, Maisels MJ, Young BW, Wong RJ, Vreman HJ, et al. prediction of hyperbilirubinemia in near-term and term infants. Pediatrics. 2001; 108(1):31-9.
  4. Bhutani VK, Johnson L, Sirieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999; 103(1):6-14.
  5. Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000; 106(2):E17.
  6. Hemmati F, Kiyani Rad NA. The value of bilicheck® as a screening tool for neonatal jaundice in the south of Iran. Iran J Med Sci. 2013; 38(2):122-28.
  7. Kaur S, Chawla D, Pathak U, Jain S. Predischarge non-invasive risk assessment for prediction of significant hyperbilirubinemia in term and late preterm neonates. J Perinatol. 2012; 32(9):716-21.
  8. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infants 35 or more weeks of gestation. Pediatrics. 2004; 114(1):297-316.
  9. Jacobson MP, Bernstein HH. Limited diagnostic value of routine cord blood bilirubin determination. Clin Pediatr (Phila). 1982; 21(10):610-2.

10. Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Paediatr Sc and. 1989; 78(2):217-21.

11. Satrya R, Effendi SH, Gurnida DA. Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns. Paediatr Indones. 2009; 49(6):349-54.

12. Kanchanabat S, Boonyarittipong P, KreinghirunO. Prediction of hyperbilirubinemia in term newborns by umbilical cord blood bilirubin. Vajira Med J. 2010; 54(2):147-57.

13. Bernaldo AJ, Segre CA. Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia. Sao Paulo Med J. 2004; 122(3):99-103.

14. Knupfer M, Pulzer F, Gebauer C. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinemia. Acta Paediatr. 2005; 94(5):581-7.

15. Sun G, Wang YL, Liang JF, Du LZ. Predictive value of umbilical cord blood bilirubin level for subsequent neonatal jaundice. Zhonghua Er Ke Za Zhi. 2007; 45(11):848-52.

16. Nahar Z, Shahidullah M, Mannan M, Dey SK, Mitra U, Selimuzzaman SM.The value of umbilical cord blood bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy newborn. Bangladesh J Child Health. 2009; 33(2): 50-4.

17. Ambalavanan N, Carlo WA. Jaundice and hyperbilirubinemia in the newborn. In: Kliegman RM, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011. P.603-60.

18. Carbonell X, Botet F, Figueras J, Riu-Godó A. Prediction of hyperbilirubinaemia in the healthy term newborn. Acta Paediatr. 2001; 90(2):166-70.

19. Rostami N, Mehrabi Yad Elah, Asadzadeh F. Identifying the newborns at risk for developing significant hyperbilirubinemia by measuring cord bilirubin levels. Pejouhandeh. 2005; 9(6):365-9.

20. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or =35 weeks' gestation: an update with clarifications. Pediatrics. 2009; 124(4):1193–8.

21. Kaplan M, Bromiker R, Schimmel MS, Algur N, Hammerman C. Evaluation of discharge management in the prediction of hyperbilirubinemia: the jerusalem experience. J Pediatr. 2007; 150(4):412-7.

22. Maisels MJ. Risk assessment and follow-up are the keys to preventing severe hyperbilirubinemia. J Pediatr (Rio J). 2011; 87(4):275-6.

23. Punaro E, Mezzacappa MA, Facchini FP. Systematic follow-up of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks. J Pediatr (Rio J). 2011; 87(4):301-6.